Practice patterns and outcomes of local and systemic therapy for single-site metastatic non-small cell lung cancer in the era of immunotherapy.
- 1Division of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn.
Abstract
Objective
Prognosis of lung cancer with single metastatic sites in the era of immunotherapy remains poorly described. We used the National Cancer Database to assess how metastatic site and the use of local therapy with systemic immunotherapy is associated with prognosis in the United States.Methods
Patients with clinical stage IVA lung cancer treated with immunotherapy were identified in the National Cancer Database (2018-2023). Patients were stratified by metastatic site and treatment: systemic immunotherapy with or without local therapy (immunotherapy + local therapy or immunotherapy). Prognosis was evaluated using Kaplan-Meier and Cox survival analysis landmarked at median time from diagnosis to local therapy.Results
Among included patients (N = 20,214), metastases included lung (N = 5308; 26.3%), brain (N = 3516; 17.4%), bone (N = 3142; 15.5%), distant lymph node (N = 1219; 6.0%), liver (N = 874; 4.3%), and other metastases (N = 6155; 30.4%). A total of 13,890 patients (68.7%) were treated with immunotherapy, and 6324 patients (31.3%) were treated with immunotherapy + local therapy (70.2% received chemotherapy, 27.2% radiation, and 9.8% surgery). Poor 5-year overall survival was associated with bone (20.9%) and liver (15.9%) metastases compared with brain (33.4%). Five-year survival was greater in patients selected for local therapy (30.3% vs 20.5%, P < .001); thoracic and extrathoracic local therapy was associated with greater overall survival compared with extrathoracic local therapy alone (37.7% vs 28.2%, P < .001). Differences in 5-year survival with local therapy varied by metastatic site (10.4% lung, 7.1% brain, 0.1% liver).Conclusions
The addition of local therapy to a systemic regimen containing immunotherapy was common for patients with single metastatic sites. Patients selected for local therapy had a more favorable prognosis, which varied by metastatic site.
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BibTeX
@article{esnaola2026practice,
title = {{Practice patterns and outcomes of local and systemic therapy for single-site metastatic non-small cell lung cancer in the era of immunotherapy.}},
author = {Gabriela Esnaola and Maureen Canavan and Giorgio Caturegli and Abigail Lynch and Benjamin Resio},
journal = {JTCVS open},
year = {2026},
month = jul,
doi = {10.1016/j.xjon.2026.101949},
url = {https://europepmc.org/article/MED/42948095},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Practice patterns and outcomes of local and systemic therapy for single-site metastatic non-small cell lung cancer in the era of immunotherapy.
AU - Gabriela Esnaola
AU - Maureen Canavan
AU - Giorgio Caturegli
AU - Abigail Lynch
AU - Benjamin Resio
PY - 2026
DA - 2026/07/02
JO - JTCVS open
DO - 10.1016/j.xjon.2026.101949
UR - https://europepmc.org/article/MED/42948095
AB - Objective Prognosis of lung cancer with single metastatic sites in the era of immunotherapy remains poorly described. We used the National Cancer Database to assess how metastatic site and the use of local therapy with systemic immunotherapy is associated with prognosis in the United States.Methods Patients with clinical stage IVA lung cancer treated with immunotherapy were identified in the National Cancer Database (2018-2023). Patients were stratified by metastatic site and treatment: systemic immunotherapy with or without local therapy (immunotherapy + local therapy or immunotherapy). Prognosis was evaluated using Kaplan-Meier and Cox survival analysis landmarked at median time from diagnosis to local therapy.Results Among included patients (N = 20,214), metastases included lung (N = 5308; 26.3%), brain (N = 3516; 17.4%), bone (N = 3142; 15.5%), distant lymph node (N = 1219; 6.0%), liver (N = 874; 4.3%), and other metastases (N = 6155; 30.4%). A total of 13,890 patients (68.7%) were treated with immunotherapy, and 6324 patients (31.3%) were treated with immunotherapy + local therapy (70.2% received chemotherapy, 27.2% radiation, and 9.8% surgery). Poor 5-year overall survival was associated with bone (20.9%) and liver (15.9%) metastases compared with brain (33.4%). Five-year survival was greater in patients selected for local therapy (30.3% vs 20.5%, P < .001); thoracic and extrathoracic local therapy was associated with greater overall survival compared with extrathoracic local therapy alone (37.7% vs 28.2%, P < .001). Differences in 5-year survival with local therapy varied by metastatic site (10.4% lung, 7.1% brain, 0.1% liver).Conclusions The addition of local therapy to a systemic regimen containing immunotherapy was common for patients with single metastatic sites. Patients selected for local therapy had a more favorable prognosis, which varied by metastatic site.
SN - 2666-2736
ER -